Hurricane-related maternal stress, infant outcomes and resilience factors

摘要： 对于许多波多黎各人来说，2017年9月20日发生的事情类似于拥有一枚核弹 在好莱坞电影中看到的进攻。事实上，这可能与发生的情况很接近。在它的生命中 根据NASA的计算，平均一次飓风可以消耗10,000枚核弹的能量。AS 截至2018年3月，在飓风玛丽亚过去近6个月后，PR政府计算出 家庭仍然缺乏电力。这场灾难的影响包括20个小时左右的经历 狂风、噪音、黑暗以及对生命和财产的恐惧，但最初几周的停电和 通讯，中断的服务，燃料的稀缺，黑暗和空荡荡的街道，每一天都需要现金 交易之后是几个月的缓慢复苏。人们忍受着最初的混乱，希望 迅速恢复服务，这变成了沮丧和愤怒。在这方面，孕妇 经历过产前护理和监测中断，无论怀孕三个月。我们相信这一延期 几个月没有正常，增加了母亲的压力，影响了护理和服务，并可能影响其他 儿童未来的结果。婴儿的不良结局可能是由于体内胰岛素水平升高所致。 子宫母亲压力，产后母亲压力，缺乏足够的营养或卫生条件，缺乏 适当的儿科预防和急救后立即护理，降低了对儿科的依从性 由于缺乏基础设施、交通、相互竞争的优先事项和不堪重负的家庭而受到照顾。家庭 支持可能在缓冲影响和不利后果方面发挥了重要作用，或者在更 支持弹性的主动角色。如果我们不这样做，这场飓风的影响将产生长期后果 制定适合特定群体和社区的干预措施。这是一项混合方法的研究， 以下目标：1.比较灾难(飓风玛丽亚及其后果)对油井的影响- 母亲和孩子接触这一事件的时间不同：怀孕期间暴露与最近暴露 妇女的母性；婴儿的宫内和产后；2.探索(通过深入访谈)影响， 在飓风期间和飓风过后，母亲们关于接触(或缺乏)的个人意义和意义 到保健、医疗和社会服务以及包括家庭和社区在内的各种支助系统，以 这两组母亲和3.确定特定的弹性因素，将会改善不利的 飓风相关应激经历对母婴的影响 这对这些人口的健康具有重要意义，可以为灾后的文化敏感干预措施提供信息。

Abstract: For many Puerto Ricans, what happened on September 20th, 2017 was similar to having a nuclear bomb attack as seen on Hollywood movies. In fact, this is might have been close to what happened. During its life cycle, an average Hurricane can expend as much energy as 10,000 nuclear bombs as calculated by NASA. As of March 2018, almost 6 months’ post Hurricane Maria, the Government of PR has calculated that 100,000 households are still lacking power. The impact of this catastrophe includes the 20 hours or so of experiencing heavy winds, noise, darkness and fear for life and property, but the initial weeks of lack of power and communications, interrupted services, scarcity of fuel, dark and empty streets, need for cash for every transaction followed by months of slow recovery. The population endured the initial disruption with the hope of quick restoration of services which transformed to frustration and anger. In this context, pregnant women experienced disruption of prenatal care and monitoring, regardless of the trimester. We believe this extension of months without normality, added to maternal stressors, impacted care and services and might affect other children’s outcomes in the future. Adverse infant outcomes might have been caused by elevated levels of in utero maternal stress, post-natal maternal stress with lack of adequate nutrition or sanitary conditions, lack of proper pediatric preventive and acute care in the immediate aftermath, decreased compliance with pediatric care due to lack of infrastructure, transportation, competing priorities and overwhelming of families. Family support might have played an important role in buffering the impact and adverse consequences or in a more active role supporting resiliency. The impact of this Hurricane will have long-lasting consequences if we do not develop interventions appropriate for specific groups and communities. This is a mixed methods study with the following aims: 1. To compare the impact of a catastrophe (Hurricane Maria and its aftermath) on the well- being of mothers and children with different timing exposure to the event: exposed during pregnancy vs. recent motherhood for women; in-utero vs post-natal for infants; 2.To explore (with in-depth interviews) the impact, personal meaning and sense-making by mothers during and after the Hurricane regarding access (or lack of) to health care, medical and social services and diverse support systems, including family and community, for both groups of mothers and 3. To identify specific resilience factors that would have ameliorated the adverse effects observed as a consequence of Hurricane-related stressful experiences on the maternal and infant health of this population and that can inform culturally sensitive interventions post disaster.